(Bloomberg) — Senate Republican leaders head into a difficult fight this week to win support for their health care legislation after returning from a recess where some GOP lawmakers fielded angry complaints from constituents about the measure.
Senate Majority Leader Mitch McConnell has made little progress on winning over his party’s holdouts as he negotiates with them over revisions to a bill he proposed last month that combines tax cuts with deep reductions in health spending. Changes under consideration include ditching a repeal of the Affordable Care Act tax increases on the wealthy, revising Medicaid cuts and adding more spending to stabilize premium costs in the individual insurance market, according to a GOP aide who requested anonymity.
(Related on ThinkAdvisor: 4 ACA Change Paths That Just Got More Popular)
McConnell has little time to make a deal. Republican leaders have said they need to move on to other issues, including a tax-code overhaul and next year’s spending bills, if they can’t agree on a health bill before a month-long August break. For the bill to pass, and Republicans to live up to their promise to eliminate President Barack Obama’s signature domestic accomplishment, they can lose no more than two GOP votes from their 52-48 majority amid unanimous Democratic opposition.
Republicans say they’re increasingly pessimistic the GOP legislation can win approval.
Sen. Bill Cassidy of Louisiana said on “Fox News Sunday” that McConnell’s original plan is dead and that what happens with the rewritten version remains to be seen. He put the odds of passing a bill in July at “50-50.”
Given the lack of support for McConnell’s legislation, Sen. John McCain of Arizona said on CBS’s “Face the Nation” that Republicans should write a new bill and let Democrats offer amendments. “That’s what democracy is supposed to be all about,” he said.
McConnell himself took a risk on Thursday by calling for a bipartisan health care plan if the Republican-only bill fails. He told an audience in his home state of Kentucky that the Affordable Care Act needs to be altered, as insurers are pulling out of some areas. McConnell’s message could serve as a warning to holdout conservative Republicans most ideologically opposed to the Affordable Care Act, but the remarks also may give wavering moderates cover to oppose the GOP plan.
The Trump administration is taking a more optimistic view on passing a bill. The Senate may delay its August recess to finish the health care overhaul, White House Chief of Staff Reince Priebus predicted on “Fox News Sunday.”
McConnell is awaiting estimates from the Congressional Budget Office of possible changes to his bill to determine whether they would increase spending or alter estimates of the number of people who would lose their health coverage. The CBO said the initial proposal from McConnell would cause 22 million fewer Americans to have health insurance in a decade.
“Discussions about the legislation continue within the conference and with CBO,” said David Popp, McConnell’s spokesman.
Republican leaders are considering axing plans to repeal nearly all of the tax increases that help finance the Affordable Care Act, said the GOP aide. The GOP health bill may retain a 3.8% investment tax on high-income earners and a Medicare earned-income surcharge on the wealthy.
Those two tax increases generate nearly $231 billion in revenue over a decade, according to the Joint Committee on Taxation. Leaving them in place could create a way to cover the costs of expanded Medicaid coverage for the poor or other programs demanded by holdout moderate Republicans.
There likely will be changes to the Medicaid provisions in McConnell’s earlier proposal based on feedback from senators, the aide said. These changes are proving to be among the most difficult to negotiate as GOP senators have vastly different requests based on their states’ needs, the aide said.
Sen. Ted Cruz, R-Texas (Photo: Cruz)